Author(s)
Matthew S. Krutz, MD
Saleem Batman, BS
Greg Krempl, MD
Affiliation(s)
University of Oklahoma;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to recognize the importance of intraoperative recognition of laryngeal injury during a Sistrunk procedure and understand the potential functional consequences of this complication if not managed adequately.
Objectives: We report the occurrence of a right hemilaryngectomy defect as a complication of a Sistrunk procedure along with the short term management and clinical outcomes.
Study Design: A 4 year old underwent a Sistrunk procedure at an outside facility complicated by a reported tracheal injury which was sutured closed. In recovery, he developed respiratory insufficiency and was intubated and transferred to our facility. The patient underwent CT scan which revealed a defect in both the hyoid and the right side of the thyroid cartilage.
Methods: Microlaryngoscopy revealed disruption of the right true vocal cord, false cord, pyriform sinus, and thyroid cartilage along with exposed arytenoid cartilage. The mucosal loss was significant enough that it was not amenable to cartilage grafting. Hypopharyngeal mucosa was used to cover the exposed arytenoid cartilage, and the strap muscles were rotated over to repair the laryngeal defect. A tracheostomy was then performed.
Results: 3 years postoperatively, scarring had resulted in rightward laryngeal rotation and the patient had an audible, but weak voice, and continued to be tracheostomy dependent.
Conclusions: This is the first report of a laryngectomy defect complicating a Sistrunk procedure with enough mucosal loss it was not amenable to cartilage grafting. Conservative repair was effective in managing the acute injury, but long term has left significant functional deficits, that will require future reconstruction. Should this injury be encountered in the future, one might consider immediate complex reconstruction to attempt improved functional outcomes.